Showing the realities of hospital life, not the sanitised crap this lot in power think we should believe.

Looking forward to that, did my nurse training there late 90’s.

Ta for reminder.

Showing the realities of hospital life, not the sanitised crap this lot in power think we should believe.

You reckon so? 24hrs in A&E is not like the reality. Reality unfortunately doesn’t make good TV

so Casualty and Holby aren’t real?

I managed a city centre-based group of theatres, anaesthesia, critical care and some other bits and bobs for 4 years until 2009. This will be interesting to watch…

Lots familiar so far – I spent countless miserable days doing the painstaking work of finding beds (ITU beds being top of tree) to keep things moving.

I think there will be an oesophagectomy featured somewhere in this episode… I vividly remember having to speak to the wife of a gentleman waiting for said op (elective) and had been cancelled twice before on the day of surgery. She kept on asking me – through tears – to promise an ITU bed and I couldn’t. Trying to explain the delicate balance of elective and emergency care to someone who is watching their loved on dying wasn’t going to do much good: to her, this was an emergency. By fluke, it was 3rd time lucky for them.

After a few months of this (all very normal, especially in winter), the best I could do was to present the week’s elective cases in advance to the surgeons with a suggestion for priorities. They then had to agree this between themselves the order (1, 2, 3 etc). When we didn’t have enough beds, this agreeing things up front removed a surprising amount of aggro.

Given that I’ll be living it tomorrow, I’m not watching.

Which hospital is it?

St Mary’s

Last few days of my hols so getting some refresher training in.

Shit, it’s pretty bleak. Feel desperately sorry for the people having to manage this situation.

In preemptive response to the inevitable “why don’t they just add some more ITU / HDU beds” question:

The issue with ITU / HDU beds is how expensive they are. Commissioners (purse-string holders in NHS) really don’t like more critical care bed days because it cripples finances.

More critical care bed days = less money for cancer drugs etc etc.

The ITU/ICU bed issue is more unique to major trauma centres (like on this programme)

Your average DGH just doesn’t have enough ward beds.

Both areas are being pushed

Definitely not unique to major trauma centres. Anaesthetic/ICU trainee currently in a DGH, and lack of available critical care beds affects both elective and Emergancy work all too commonly.

Often the problem (in both DGHs and major trauma centres) is a lack of available beds in less acute areas of the hospital to “step down” the patients not needing intensive care input anymore.

Many of the problems being seen at the moment – ambulance stacking, long waits in ED, patients in corridors, cancelled elective ops are not really down to the capacity of those areas, but because of blockages in the system downstream. Go to any of the hospitals struggling in the last few weeks and I’m sure you’d find numerous patients medically fit for discharge but needing care packages, care home placement etc before they can be discharged. It’s a crude analogy, but if your baths overflowing, a bigger bath isn’t the answer, in time it’ll fill full as well and you’ll just have a larger scale problem. The answers a bigger plug-hole!

The ITU/ICU bed issue is more unique to major trauma centres (like on this programme)

No it’s not. Our network has been heaving for weeks.

The issue with ITU / HDU beds is how expensive they are. Commissioners (purse-string holders in NHS) really don’t like more critical care bed days because it cripples finances.

They’re expensive because they’re staffing and equipment intensive (remember that ‘an ITU bed’ actually means ‘an ITU nurse who hasn’t got a patient’ and IIRC each L3 bed needs 6WTE nurses). We spend ages in meetings looking at our occupancy, which should be <85%, but in general the U.K. has the lowest number of critical care beds per head of population in N Europe.

Ecampbell has got it; big problem is lack of social care, which I think are a result of cuts to council funding,

Brilliant programme. IMO in need of a much greater audience than that available on BBC2. Really drives home the problems faced by you guys to the layman’s such as myself.

The Beeb really do excel at this kind of TV.

I watched that fascintaed. Fascinated by a number of things but overwhelmingly by the care and compassion of all the staff (I’m sure there are exceptions but I didn;t see them). Managing a system like that and making those decisions must be incredibly difficult. Chapeau and as said above a well made docco.

Same message 40 years ago.

[video]https://m.youtube.com/watch?v=9voFVUzbxOM[/video]

Your average DGH just doesn’t have enough ward beds.

And yet when you are in one it’s murder to get discharged.

As per above – issue is social care. Patients can wait 21 days plus once medically fit (i.e. don’t need a hospital bed) for social care.

Social care = council budget, hospital bed = NHS budget. Need to combine them – then there is a major incentive to get the person to the right and most cost effective place.

Sounds harsh to talk about the cost – but ultimately there is one and it all comes out of one UK plc pot – so has to be spent as cost efficiently as possible while delivering best possible care.

ScottChegg – Member 

Your average DGH just doesn’t have enough ward beds.

And yet when you are in one it’s murder to get discharged.

Exactly. I was ready to go and told doctor would be along to do a final check and can go. He didn’t turn up until the next day. I was taking up bed space in a trauma ward. Suppose I could have just walked out.

I didnt expect the end credit.

a well made programe those patients where so brave to appear on the programe, and a big thanks to the staff who allowed such open filming.

Now a question, if there is a serious event , eg coach /train or plane crash with multiple casualties,anywhere in the uk, just where and who are going to treat the injured patients.
The room is full, now an extension needs to be built and soon

I understand that an ITU bed (and the corresponding staff) is expensive – but the waste that was shown last night with a surgeon, an anaesthetist and several nurses on standby all day doing nothing constructive due to the lack of a bed was fantastically wasteful also.

The ITU/ICU bed issue is more unique to major trauma centres (like on this programme)

Your average DGH just doesn’t have enough ward beds.

Both areas are being pushed

This is total bollox. We don’t have enough of either – and the lack of ward beds often means that we cant get them out of our ITU when well, further compounding the problem.

I work in North Wales – UK has lowest number of ITU beds per head of population in Europe – we have lowest number of ITU beds per head of population in UK – go figure!

They will be spread across local hospitals first, then near by counties and further afield if need be. Day beds would be used and a huge plan to shift people out as quick as possible.

On scene treatment where possible and large causality areas set up on scene as well as receiving hospitals.

It’s a massive contingency plan.

Drac – Moderator

Same message 40 years ago.

Yep. However 40 years ago you didn’t need an appointment to see your GP, you just turned up and waited for your turn (a lot quicker than waiting at A&E) Today waiting several days to see a GP is fairly normal. I can’t help thinking all that must put a fair amount of pressure on A&E.

Also 40 years ago before ‘care in the community’ the mentally ill were less likely to be walking the streets, and city centres didn’t have a multitude of rough sleepers in shop doorways, I also can’t help thinking that must also put extra strain on A&E compared to 40 years ago.

Also 40 years ago before ‘care in the community’ the mentally ill were less likely to be walking the streets

Don’t forget, though, that life in those state-run mental hospitals was not fun – it was horrific for many of the patients, who were effectively written off by society. Closing those hospitals was definitely a good thing.

Don’t forget, though, that life in those state-run mental hospitals was not fun

Yes but the point I was making was that if mental health issues arose they could dealt with in an environment other than A&E.

EDIT : BTW I wouldn’t simply write-off psychiatric hospitals – they can very clearly have an extremely useful role to play. For both voluntary and non-voluntary patients.

Don’t forget, though, that life in those state-run mental hospitals was not fun – it was horrific for many of the patients, who were effectively written off by society. Closing those hospitals was definitely a good thing.

I worked in one for 6 great years, staff where usually good with patients, they had a warm bed, food and tv,fags,they had baths, and large grounds to wander round in, good healthcare for medical conmditions, also some did jobs around the hospital and got some pocket money.

then they where shifted into small houses in the community thrown out all day to wander the streets of the local town or city, having little cash, they stopped taking their medication, they relapsed, and had nowhere to go for safety, they fought, or injured themselves to get attention, and caused upset to neighbours.

The only place for the police to take them is a and e, and then where do they go , discharged back into the community, that basicly doesnt want them.

and that can happen to anyone of us, mental illness.

Oh, I agree – the “care” bit of “care in the community” was woefully underfunded and forgotten.

It’s a bit to simplistic to say ‘lack of social care’ in our area. There are areas of my county that have poor domiciliary agency cover, private agencies aren’t set up to start packages over weekends and generally carer posts are hard to recruit to. But equally, poor commissioning of community health care assistants for admission prevention and early discharge scheme’s compounds these issue’s. With health carer post’s paying more, for post’s with better contract hours (7am-7pm contracts, compared to 6am-10pm social care contracts. Health care assistants not able to prompt and assist with medication, unlike the council ‘home helps’.

I see social care respite beds, being given to health for rehab/ intermediate care, but no therapy staff to co-ordinate admissions after 5pm, or at weekends. I see the hospital social worker’s getting sent to cover community work due to a lack of discharge work. As they can’t sort discharges as we haven’t got therapy staff to sign of discharges, or medics signing off meds, and problems with transport. We seem blighted by death by new initiatives, which all seem to be aimed at clearing the wards but work to different criteria, and seem to perscribe care in an almost random manner, and this simply doesn’t tie in to social care managing care provision under the guidance of the Care Act.

Our community beds seem a holding bay for patients needing continuing health care assessment and case management, and I’m embarrassed by the treatment of people who are ‘fast tracked’ and want to die at home on a weekend. There is certainly some work to do across health and social care.

The Clinical Director lady nails it. “We get sick of being told to be efficient. There’s only so efficient you can be.”

If I could dangle one thing in front of the Tory rule book it would be that.

I watched it after seeing this thread. Great program at highlighting how much goes on in the back ground and how much time is wasted just hanging around to resolve bed issues.

I think people forget the admin people and managers in the background trying to run the hospital as well as all the nurses and doctors who just want to do their job.

The Clinical Director lady nails it. “We get sick of being told to be efficient. There’s only so efficient you can be.”

If I could dangle one thing in front of the Tory rule book it would be that.

Like Michael Gove, who wanted every school to be better than average…

That cartoon human…

Just to lighten the tone a bit;

“So you’re in for life saving surgery and we’re just waiting to free up a bed. Have you any questions I can help with just now?”
“Well, I have already paid £10.80 for parking and if we are going to be here all day it will cost a lot more, so…”.
“No, I meant questions about the operation”

Gold!

but the waste that was shown last night with a surgeon, an anaesthetist and several nurses on standby all day doing nothing constructive due to the lack of a bed was fantastically wasteful also.

I would imagine that the surgeon, anaesthetist and nurses (I presume theatre nurses) would try and help with emergency cases off the emergency theatre list, or help out other surgeons who’s own operating lists are unrealistic for the time they are given. I really don’t think they’d be sitting around drinking coffee all day getting paid just because the case they were all waiting to do, which would take the best part of a day, was cancelled due to a lack of its beds.

on again tonight

Is this a 24hrs in A&E sort of thing?

Sort of Jamie but more about the management of the hospital.

shows the strugle about bed occupancy and the patients who are sometimes having to be cancelled for elective surgery, due to no beds being available.

😥